Provider Demographics
NPI:1487304085
Name:ENGLAND, SHANA LYNN (RDH)
Entity type:Individual
Prefix:
First Name:SHANA
Middle Name:LYNN
Last Name:ENGLAND
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:139 VICTORY LN
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37615-3502
Mailing Address - Country:US
Mailing Address - Phone:423-557-6437
Mailing Address - Fax:
Practice Address - Street 1:2800 PEOPLES ST STE 90
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-4158
Practice Address - Country:US
Practice Address - Phone:423-928-0345
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-25
Last Update Date:2022-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDH5461124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist